Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Kentucky for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Kentucky only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Kentucky (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Kentuckyone Health Medical Group, Inc. (NPI 1104875970)

Kentuckyone Health Medical Group, Inc. is a family medicine physician provider located in Lexington, Kentucky. This profile covers 0 Medicare and 274 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Kentuckyone Health Medical Group, Inc.
Address	1401 Harrodsburg Rd
City	Lexington
State	KY
ZIP	40504
Taxonomy	Family Medicine Physician
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicaid	$38.9M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

274 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	242,280	$40	$9.4M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	262,930	$30	$7.4M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	28,360	$80	$2.3M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	35,960	$40	$1.6M
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	18,490	$70	$1.3M
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	175,090	$10	$1.2M
J0585	Injection, onabotulinumtoxina, 1 unit	2,280	$530	$1.2M
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	22,040	$50	$1.1M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	8,030	$110	$875.7K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	14,040	$50	$758K

Showing 1–10 of 274

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.

Claims Volume vs. Kentucky Distribution

Kentuckyone Health Medical Group, Inc. — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

274 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0585	Injection, onabotulinumtoxina, 1 unit	5	20	460	$540	$739.9K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	4	210	1,340	$160	$568K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	26	60	170	$780	$500.2K
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	26	40	120	$1,340	$494.5K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	419	1,270	760	$80	$447.2K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	8	170	1,300	$230	$441K
95720	A physician or other QHCP reviews recorded events and analyzes spike and seizure detection of a continuous electroencephalography, a study of the electrical activity of the brain. A video is…	3	10	3,300	$110	$420.3K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	16	130	420	$270	$375.3K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	173	200	16,730	$10	$365.9K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	15	3,340	1,020	$30	$296K

Showing 1–10 of 274

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Joseph Health System, Inc	KY	General Acute Care Hospital	$0	$85.5M
Saint Joseph Health System, Inc	KY	Rural Acute Care Hospital	$0	$83.7M
Saint Joseph Health System, Inc	KY	General Acute Care Hospital	$0	$67.4M
Saint Joseph Health System, Inc	KY	General Acute Care Hospital	$0	$37.2M
Saint Joseph Health System, Inc	KY	Critical Access Hospital	$0	$29.8M
Shawn Milburn	KY	Pain Medicine (Anesthesiology) Physician	$389.7K	$0
Robert Lavey	KY	Radiation Oncology Physician	$384.3K	$0
Emmanuel Nidhiry	KY	Medical Oncology Physician	$347.6K	$0
Mark Esterle	KY	Pulmonary Disease Physician	$283.6K	$0
Shoaib Ahmad	OK	Pulmonary Disease Physician	$276.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maxim Healthcare Services Inc.	KY	Home Health Agency	$0	$20.5M
Hospice Of The Bluegrass, Inc	KY	Community Based Hospice Care Agency	$0	$17.9M
Columbus Medical Services, LLC	KY	Case Management Agency	$0	$12.1M
Hospice Of The Bluegrass, Inc	KY	Community Based Hospice Care Agency	$0	$9.3M
Horn And Associates In Rehabilitation PLLC	KY	Rehabilitation Practitioner	$0	$8.3M
New Lexington Clinic, Psc	KY	Multi-Specialty Clinic/Center	$0	$8.2M
Serenity Keepers	KY	Adult Mental Health Clinic/Center	$0	$7.9M
Lexington Surgery Center Ltd	KY	Ambulatory Surgical Clinic/Center	$1.3M	$5.4M
Cogent Healthcare Of Kentucky, Psc	KY	Internal Medicine Physician	$0	$4.4M
Encompass Health Rehabilitation Hospital Of Cardinal Hill, LLC	KY	Rehabilitation Hospital	$0	$4.2M

Kentuckyone Health Medical Group, Inc. — Billing Profile & Reimbursement Data

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Kentuckyone Health Medical Group, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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